OTHER REFERENCE/RESOURCE DATA FILES

The files in this group provide references to information ranging from hospital finances and facilities to Medicare Fiscal Intermediary (FI) geographic areas. Such reference information is used by CMS (previously HCFA) in conjunction with administrative and analytic files. The following files are included in this group:

• Carrier/Intermediary Workload Statistics
• Clinical Laboratory Improvement Amendments (CLIA) Database
• Prospective Payment System (PPS) Metropolitan Statistical Area/Business Enterprise Area (MSA/BEA)
• ZIP Code Directory

Carrier/Intermediary Workload Statistics File

The Carrier/Intermediary Workload Statistics File contains information submitted to CMS (previously HCFA) by carriers and FIs on the HCFA Form 456, Intermediary Benefit Payment Report, which includes data on FIs only; the HCFA Form 1521, Contractor Financial Draws on Letter of Credit; and the HCFA Form 1522, Monthly Contractor Financial Report. These reports are used by CMS to reconcile its accounts with information maintained by carriers and FIs.

Clinical Laboratory Improvement Amendments (CLIA) Database

The CLIA Database supports the CLIA amendments of the Public Health Service Act of 1988 that expanded DHHS authority to regulate all clinical laboratories. The CLIA 1988 amendments require that any entity performing laboratory testing be certified or have a certificate of waiver, and comply with the laboratory testing standards established by DHHS.

The CLIA Database provides descriptive information about all DHHS-certified laboratories. This information includes personnel, type of testing performed, proficiency data, testing volume, laboratory location, and the name of the laboratory director. Laboratories are required to provide CMS with up-to-date information every two years.

The CLIA Database is a subsystem of Online Survey Certification and Reporting System (OSCAR). The database is organized by provider type and corresponding CLIA number. Further information regarding OSCAR can be found in the Provider of Services Data chapter in the Data Section of the guide.

Prospective Payment System (PPS) Metropolitan Statistical Area/Business Enterprise Area (MSA/BEA) File

The PPS MSA/BEA File contains crosswalk records that include the county name, FIPS state and county codes, SSA state and county codes, and MSA/BEA assignment of each state and county in the nation. The file includes a history of MSA assignments since October 1983, and is updated only if there is a change in assignment.

ZIP Code Directory File

The ZIP Code Directory File contains a directory of all city and county ZIP Code jurisdictions in the United States.

Introduction | Payment Policy Files | Other Reference/Resource Data Files